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Treovance 支架移植物血管内动脉瘤修复的全球上市后临床随访:RATIONALE 注册研究的一年结果。

Global Post-Market Clinical Follow-up of the Treovance Stent-Graft for Endovascular Aneurysm Repair: One-Year Results From the RATIONALE Registry.

机构信息

1 John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK.

2 Azienda Ospedaliera Universitaria Senese, Siena, Italy.

出版信息

J Endovasc Ther. 2018 Dec;25(6):726-734. doi: 10.1177/1526602818803939. Epub 2018 Oct 3.

Abstract

PURPOSE

: To evaluate the safety and performance of the Treovance stent-graft.

METHODS

: The global, multicenter RATIONALE registry ( ClinicalTrials.gov; identifier NCT03449875) prospectively enrolled 202 patients (mean age 73.0±7.8 years; 187 men) with abdominal aortic aneurysms (AAA) suitable for endovascular aneurysm repair (EVAR) using the Treovance. The composite primary safety endpoint was site-reported all-cause mortality and major morbidity. The primary efficacy outcome was clinical success. Further outcomes evaluated included technical success; stent-graft migration, patency, and integrity; endoleak; and aneurysm size changes.

RESULTS

: Technical success was 96% (194/202); 8 patients had unresolved type I endoleaks at the end of the procedure. There was no 30-day mortality and 1% major morbidity (1 myocardial infarction and 1 bowel ischemia). Clinical success at 1 year was confirmed in 194 (96%) patients; 6 of 8 patients had new/persistent endoleaks and 2 had aneurysm expansion without identified endoleak. A total of 8 (4%) reinterventions were required during the mean 13.7±3.1 months of follow-up (median 12.8). At 1 year, the Kaplan-Meier estimate for freedom from reintervention was 95.6% (95% CI 91.4% to 97.8%). Other estimates were 95.5% (95% CI 91.7% to 97.6%) for freedom from endoleak type I/III and 97.4% (95% CI 94.2% to 98.9%) for freedom from aneurysm expansion. Thirteen (6.4%) patients died; no death was aneurysm related.

CONCLUSION

: The RATIONALE registry showed favorable safety and clinical performance of the Treovance stent-graft for the treatment of infrarenal AAAs in a real-world setting.

摘要

目的

评估 Treovance 支架移植物的安全性和性能。

方法

全球多中心 RATIONALE 注册研究(ClinicalTrials.gov;标识符 NCT03449875)前瞻性纳入 202 例适合 Treovance 血管内动脉瘤修复术(EVAR)的腹主动脉瘤(AAA)患者(平均年龄 73.0±7.8 岁;187 例男性)。复合主要安全性终点为部位报告的全因死亡率和主要发病率。主要疗效结果为临床成功。进一步评估的结果包括技术成功率;支架移植物迁移、通畅性和完整性;内漏;以及动脉瘤大小变化。

结果

技术成功率为 96%(194/202);8 例患者在手术结束时仍存在未解决的 I 型内漏。30 天内无死亡,1%的主要发病率(1 例心肌梗死和 1 例肠缺血)。194 例(96%)患者在 1 年内确认临床成功;8 例中有 6 例出现新的/持续的内漏,2 例出现动脉瘤扩大但未发现内漏。在平均 13.7±3.1 个月的随访期间(中位数 12.8 个月),共需要 8 次(4%)再介入治疗。1 年时,Kaplan-Meier 估计无再干预的自由率为 95.6%(95%CI 91.4%至 97.8%)。其他估计值为 1 型/3 型内漏无再干预的自由率为 95.5%(95%CI 91.7%至 97.6%),动脉瘤扩大无再干预的自由率为 97.4%(95%CI 94.2%至 98.9%)。13 例(6.4%)患者死亡;无动脉瘤相关死亡。

结论

RATIONALE 注册研究表明,Treovance 支架移植物在真实世界环境中治疗肾下型 AAA 的安全性和临床性能良好。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3ec7/6238168/71419f26a809/10.1177_1526602818803939-fig1.jpg

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